Card Range To Study

157 Cards in this Set

Because only a portion of the prevertebral space is indeed prevertebral (i.e. in front of the vertebrae).

What are the different portions of the perivertebral space?

The perivertebral space has a prevertebral portion, and two paraspinal portions.

What fascial layer forms the perivertebral space?

The deep layer of deep cervical fascia

How does this fascia run?

The deep layer of deep cervical fascial forms the prevertebral portion of the perivertebral space as it arches anteriorly from the transverse process to the opposite transverse process.

This fascia then continues posteriorly to completely enclose the paraspinal muscles, and attaches to the nuchal ligament of the spinous process of the vertebral body. This is the paraspinal portion of the perivertebral space.

In essence, what does the deep layer of deep cervical fascia do?

It completely encircles the perivertebral space, sectioning it off into three separate portions.

What is the craniocaudal extent of the perivertebral space?

Skull base (clivus) to T4

What do some anatomists believe about the perivertebral space?

That it extends in some form all the way down to the coccyx.

In the suprahyoid neck, what is contained within the prevertebral portion of the perivertebral space?

Prevertebral muscles

Vertebral artery and vein

Vertebral body

In the suprahyoid neck, what is contained within the paraspinal portion of the perivertebral space?

Paraspinal muscles

Posterior elements of vertebrae

Fat

In the infrahyoid neck, what is contained within the prevertebral portion of the perivertebral space?

Pervertebral muscles

Scalene muscles

Phrenic nerve

Roots of the brachial plexus

Vertebral body

In the infrahyoid neck, what is contained within the paraspinal portion of the perivertebral space?

Paraspinal muscles

Posterior elements of vertebrae

Fat

We frequently are referring to prevertebral muscles. What are the more specific names of some of these?

Longus capitis

Longus colli

Where does disease that begins in the perivertebral space usually spread?

Usually spreads into deeper recesses within the perivertebral space, like the epidural space.

Why is that?

Because the deep layer of deep cervical fascia is very very tenacious, and does not usually allow spread of disease through it.

What is another name for the deep layer of deep cervical fascia that surgeons use?

Carpet. They call it that because it appears like a smooth, flat, carpetlike surface when they approach it surgically.

What structure(s) pass through the deep layer of deep cervical fascia?

Only the roots of the brachial plexus.

How can the roots of the brachial plexus be identified on imaging?

They are laterally extending structures which pass directly posterior to the anterior scalene muscle on their way to pierce the deep layer of deep cervical fascia.

Once they pierce the deep layer of deep cervical fascia, where are the roots located?

They are now within the posterior cervical space

What are the different scalene muscles?

Anterior

Middle

Posterior

What space is directly anterior to the prevertebral portion of the perivertebral space?

The retropharyngeal/danger space

When does disease from the RPS spread into the prevertebral portion of the perivertebral space?

Only in the most extreme cases

What space is anterolateral to the pervertebral portion of the perivertebral space?

Carotid space

What space is directly lateral to the paraspinal portion of the perivertebral space?

Posterior cervical space

What space is directly posterior to the paraspinal portion of the perivertebral space?

Nothing. Just skin and the outside world.

What do clinicians sometimes confuse on their exam?

Thinking that a normal (i.e. transverse process) or abnormal mass in the paraspinal portion of the perivertebral space is in the posterior cervical space.

When features allow a mass to be considered primary to the prevertebral portion of the perivertebral space?

1) The center of the mass is within the prevertebral muscles or vertebral body.

.........AND/OR..........

2) The mass lifts the prevertebral muscles anteriorly.

In most cases, what does the anterior displacement of the prevertebral muscles by a mass in the prevertebral portion of the perivertebral space distinguish it from?

A mass in the retropharyngeal space

What features define a lesion as primary to the paraspinal portion of the perivertebral space?

1) The center of the mass is within the substance of the paraspinal musculature

........AND/OR.........

2) The mass bows the fat of the posterior cervical space away from the posterior elements of the spine.

In the case of most lesions of the perivertebral space, what is abnormal at the time of imaging?

The vertebral body.

Why?

Because the vast majority of lesions of the perivertebral space originate from the vertebral body.

What are these most typical lesions?

Infection and metastases

Clarification: What does a mass pushing on the paraspinal muscles do?

It deviates (anteriorly or posteriorly, depending if lesion is in RPS or PVS) but also flattens the prevertebral muscles

When a lesion fills the prevertebral portion of the perivertebral space, where does it often decompress or escape to?

The epidural space.

How does it get to the epidural space?

It moves in from the lateral recess

What else does it have the potential to cause much harm to?

The vertebral artery

In the infrahyoid neck, what other structures can be invaded by the mass in the prevertebral portion of the perivertebral space?

The brachial plexus roots, as they head laterally towards the scalene muscles.

In the paraspinal portion of the perivertebral space, what does the mass usually do?

If it arises in the bone, it displaces the paraspinal muscles away from the spine.

If it arises in the muscles themselves, then there will be irregularity of the muscles, blurring of fat planes, and possibly lateral deviation of the fat of the posterior cervical space.

What sometimes occurs with an infiltrative mass (infection or malignancy) of the perivertebral space?

It can traverse the fascial separation between the prevertebral and paraspinal portions of the space. But it will still remain confined by the deep layer of deep cervical fascia.

What is the first question to be asked once a mass is placed within the perivertebral space?

Is there epidural extension.

Which more commonly occurs first: Epidural extension or superficial extension through the deep layer of deep cervical fascia?

Epidural extension usually occurs LONG BEFORE a mass invades outside the bounds of the perivertebral space.

What is the categorical differential diagnosis for lesions of the perivertebral space?

1) Vascular

2) Inflammatory

3) Pseudomass

4) Benign tumor

5) Malignant tumor

What are the vascular lesions occuring within the perivertebral space?

Vertebral artery dissection

What is the clinical setting?

Posttraumatic neck pain

A variety of associated neurologic symptoms

What happens if the distal vertebral artery is involved with thrombosis?

PICA may be involved

What can occur if PICA is involved?

Lateral medullary syndrome

What is the eponym for lateral medullary syndrome?

Wallenburg syndrome

What are the MRI findings in vertebral artery dissection?

Crescentic region of high signal on T1W images within the wall of the affected artery